小结
定义
病史和体格检查
关键诊断因素
- 存在感染疟疾的风险因素
- 重症疟疾危险因素包括
- 发热或发热病史
其他诊断因素
- 头痛
- 虚弱
- 肌痛
- 关节痛
- 厌食
- 腹泻
- 惊厥
- 恶心和呕吐
- 腹痛
- 苍白
- 肝脾肿大
- 黄疸
- 意识水平改变。
- 低血压
- 出血
- 无尿或少尿
- 呼吸急促
危险因素
- 前往疫区旅行
- 药物预防不足或未采用。
- 流行地区不使用杀虫剂处理的蚊幔
- 宿主免疫力较低(重症疟疾)
- 孕妇(重症疟疾)
- <5 岁(重症疟疾)
- 免疫功能低下(重症)
- 高龄(重症疟疾)
- 铁摄入(儿童)
诊断性检查
首要检查
- 吉姆萨染色厚薄血涂片
- 快速检测试验(RDTs)
- 全血细胞计数 (FBC)
- 凝血功能检查
- 血清电解质、尿素和肌酐
- 血清肝功能检查
- 血糖
- 尿液分析
- 动脉血气
需考虑的检查
- 疟疾血液聚合酶链反应 (PCR) 检测
- 胸部 X 线检查
- 血培养
- 尿液培养
- 痰培养
- 腰椎穿刺:
- HIV 检查
- 鼻咽拭子行流感PCR检测
- 头颅 CT
新兴检查
- 环介导等温扩增
治疗流程
恶性疟原虫:无并发症,能够在开始口服药物
恶性疟原虫:重症疟疾或最初无法口服药物
卵形疟原虫
间日疟原虫
三日疟原虫或诺氏疟原虫
恶性疟原虫:复发性感染
撰稿人
作者
Elizabeth Ashley, MB BS, FRCP, FRCPath
Director
Institution Lao-Oxford-Mahosot Hospital - Wellcome Trust Research Unit
Vientiane
Laos
Honorary Consultant in Infectious Diseases and Microbiology
Oxford University Hospitals NHS Foundation Trust
Professor of Tropical Medicine
University of Oxford
Oxford
UK
利益声明
EA has active grants from a number of organisations; however, none of them are for malaria projects. EA is an associate editor of Malaria Journal, an academic editor for PLOS Medicine, and is on the Lancet Infectious Diseases International Advisory Board. EA is on the council of the International Society for Infectious Diseases and was paid by Pfizer to chair a grants committee on antimicrobial stewardship (unrelated to malaria). The Institution Lao-Oxford-Mahosot Hospital - Wellcome Trust Research Unit receives core funding from the Wellcome Trust. EA is an author of a number of references cited in this topic.
Arjun Chandna, BA MRCP AFHEA
Wellcome Trust Doctoral Training Fellow
Centre for Tropical Medicine and Global Health
University of Oxford
Oxford
Specialty Registrar in Infectious Diseases and Medical Microbiology
University College London Hospitals NHS Trust
London
UK
利益声明
None.
鸣谢
Dr Elizabeth Ashley and Dr Arjun Chandna would like to gratefully acknowledge Professor Ron Behrens, Mariyam Mirfenderesky, Dr Signe Maj Sorensen, Dr Joanna Allen, Dr Simon Warren, and Dr Behzad Nadjm, previous contributors to this topic.
利益声明
RB acted as a paid expert to the courts on malaria prophylaxis. RB received fees on the Travel Health advisory board for Emergent BioSolutions. RB prepared education material for the Royal College of Physicians and Surgeons of Glasgow. RB is an author of a number of references cited in this topic. MM, SMS, JA, and SW declare that they have no competing interests. BN is an author of a reference cited in this topic.
同行评议者
Blaise Genton, MD
Professor
Head of the Travel Clinic
Consultant of Tropical and Travel Medicine
University Hospital
Project Leader
Swiss Tropical and Public Health Institute
Basel
Switzerland
利益声明
BG has received a research grant from Novartis Pharma to assess the impact of the introduction of artemether-lumefantrine (Novartis) as first-line treatment for uncomplicated malaria on mortality of children under 5 years old in 2 districts in Tanzania and travel grants from Novartis Pharma to present the results of the study above. BG is an author of a reference cited in this topic.
David Sullivan, MD
Associate Professor
Malaria Research Institute and Department of Molecular Microbiology and Immunology
Johns Hopkins Bloomberg School of Public Health
Baltimore
MD
利益声明
DS has received royalties from antigen provision for a diagnostic test to Inverness. DS with Johns Hopkins University has patents on diagnostic tests that do not require blood.
Walther H. Wernsdorfer, MD
Professor
Institute of Specific Prophylaxis and Tropical Medicine
Medical University of Vienna
Vienna
Austria
利益声明
WHW declares that he has no competing interests.
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